Shang-Feng Tsai; Jun-Li Tsai
Volume 21, Issue 3 , 2019, Pages 1-4
Abstract
Background: Porcelain gallbladder is associated with a higher prevalence of malignancy. Prophylactic cholecystectomy is sug-gested for both symptomatic and asymptomatic patients. Although gallstones are very commonly observed in clinical practices, itis recommended in asymptomatic patients. However, ...
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Background: Porcelain gallbladder is associated with a higher prevalence of malignancy. Prophylactic cholecystectomy is sug-gested for both symptomatic and asymptomatic patients. Although gallstones are very commonly observed in clinical practices, itis recommended in asymptomatic patients. However, a ring-shaped gallstone may be easily mistaken with porcelain gallstone andrequires further investigation using computed tomography (CT) to avoid the unnecessary risks of surgery.Case Presentation: A 71-year-old female with renal dysfunction and diabetes mellitus had a ring-shaped calcification confirmedby abdominal CT scan in Taichung city of Taiwan, in 2016. She had already been followed up for at least seven years. In additionto traditional risk factors, authors believe that renal dysfunction may have also predisposed her to the development of a gallstone.The differential diagnosis of porcelain gallbladder and only ring-shaped gallstone is very important due to different treatments andoutcomes. The more attractive part of this case was that the ring-shaped gallstone is rare in clinical practices.Conclusions: For patients with a ring-shaped calcification, clinicians should rule out porcelain gallbladder since such a diagnosiswould indicate an increased risk of gallbladder carcinoma
Jun-Li Tsai; Shang-Feng Tsai
Volume 20, Issue 7 , 2018, Pages 1-4
Abstract
Introduction: Necrotizing fasciitis is not rare in clinical practice, but a Klebsiella pneumoniae-related is rare, especially in patients undergoing hemodialysis. Many patients with necrotizing fasciitis have a miserable outcome even though they receive amputation. Case Presentation: A 76-year-old male ...
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Introduction: Necrotizing fasciitis is not rare in clinical practice, but a Klebsiella pneumoniae-related is rare, especially in patients undergoing hemodialysis. Many patients with necrotizing fasciitis have a miserable outcome even though they receive amputation. Case Presentation: A 76-year-old male was initially admitted to the center due to suspected cellulitis in Taichung, Taiwan. However, the treatment response was beyond expectation, and a plain film X-ray was performed on his leg. To our surprise, it showed ap- parent gas and calciphylaxis. Easy examination detected the severe disease. Immediate surgical debridement was performed, and his legs and life were successfully saved, although the outcomes of the disease were miserable. The tissue culture yielded Klebsiella pneumoniae. This pathogen, related to necrotizing fasciitis, is rare in the currently published articles. The possible risk factors were the endemic region, diabetes mellitus, calciphylaxis, old age, frequent iron supplements, and repeated tissue hypoperfusion during hemodialysis.Conclusion: In conclusion, meticulously and timely diagnosed necrotizing fasciitis in high-risk groups is the most important factor to ensure a positive patient outcome.
